Mary is a 55-year-old female with CC of 3-month history of left sided neck and central – left upper back/scapula pain. SH: married with twin 10 year old children; she is trained as a research lab. technician but is currently a homemaker. CLOF: Mary reports she is having a “hard time keeping with her husband and children” and increasing difficulty managing her home. Even minor activities such as reaching to upper cabinets/closets, lifting and carrying groceries or laundry result in significant pain. As a result she has been very sedentary lately and feels that she fatigues easily. PLOF: Independent in all BADLs and IADLs, worked full time  PMH:  hypercholestemia (210mg/dL) SH: current smoker – 1 pack per day x 35 years MEDS: takes Tylenol for current pain; started taking over the counter allergy medicine, Zyrtec, by mouth 3 weeks ago because of recent nasal congestion and cough. She is self referred to PT with goals to decrease pain, return to regular activities and exercise, and to feel good enough to be able to start part-time work. PHYSICAL EXAMINATION: Posture and Observation: Posterior pelvic tilt, increased thoracic kyphosis, Mod forward head, C – spine in L side bend.   Height:  1.75 meters  (69 in)    Weight: 55 kg  (121 lbs)       BMI: 18.28 VSs at rest: HR 84 bpm, reg ;  RR 22,  upper chest breathing pattern  BP  120/75 Active Range of Motion: Cervical spine: flexion 0 to 30 degrees; extension 0 to 25 degrees; rotation (R) 0 to 40 degrees, (L) 0 to 15 degrees; sidebending (R) 0 to 30 degrees, (L) 0 to 20 degrees MMT Strength Testing: Upper trapezius (B) 5/5; middle trapezius (R) 3/5, (L) 2/5; lower trapezius (B) 2/5; sternocleidomastoid (B) 2/5; trunk curl 3/5; bilat leg lowering (abdominals)  2/5; Palpation: Tender to light pressure in suboccipital region, medial upper and mid trapezius, SCM origin & insertion L > R Function: sitting tol. 20 mins, standing tol. 15 mins, can lift 5lbs from knee to waist and waist to shoulder level with mild increase in discomfort; unable to lift heavier loads due to significant increase in pain, unable to lift loads from floor level, unable to reach/lift overhead due to pain.  Amb. independently indoor and outdoors w/o assistive device, up to ½ mile on level surfaces with reports of fatigue and increased discomfort/pain; Amb. elevations independently w/o AD but uses 1 rail on stairs for stability.     Question 39  List 4 KEY follow up (FUP) questions/topics that should be asked of this patient within the Review of Systems and screening for referral process.  These questions should help guide the PT in deciding whether PT and/or referal is approprriate. (2 pts)

A patient presents with c/o pain in R. knee during ambulation. Exam findings: R. knee AROM is decreased and painful; PROM is normal with “stretch like discomfort pain” at end range of Flex; Isometric testing of knee Ext reproduces pain. Given these findings, which of the following statements is the MOST appropriate clinical deduction regarding the likely source of this patient’s pain?

You measured a 70 year old female patient’s comfortable gait speed at 0.85m/s and fastest gait speed at 1.1 m/s.  Which of the following is the most accurate assessment of this finding?

 Which of the following CAN NOT be calculated using submaximal exercise testing protocol results?

In normal balance function for a young to middle aged adult, what are the relative contributions of each of the 3 systems under usual conditions? 

Which of the following examination findings indicates an increased risk for falls in a community dwelling older adult? 

Sub maximal VO2 aerobic capacity testing on a 60 yo female patient determined a baseline peak MET level of 7. How should this patient’s functional aerobic capacity be rated?    

Under HIPPA rules, under which of the following circumstances is it illegal to release private patient health information (PHI) without a competent patient’s consent?

Which of the following is a general function of bone? A. Digesting nutrients B. Electrolyte and mineral storage C. Hormone secretion D. Lymph filtration  

Which glands located in the external auditory canal produce ear wax?